Basic Information
| Provider Information | |||||||||
| NPI: | 1689832412 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAPPELL | ||||||||
| FirstName: | CRAIG | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1888 W 800 N | ||||||||
| Address2: | |||||||||
| City: | PLEASANT GROVE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840624097 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8016107321 | ||||||||
| FaxNumber: | 8016107306 | ||||||||
| Practice Location | |||||||||
| Address1: | 1888 W 800 N | ||||||||
| Address2: | |||||||||
| City: | PLEASANT GROVE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8016107321 | ||||||||
| FaxNumber: | 8016107306 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2008 | ||||||||
| LastUpdateDate: | 07/10/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 9469694-1204 | UT | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QS0010X | 9469694-1204 | UT | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 204D00000X | 9469694-1204 | UT | Y | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine & OMM |
ID Information
| ID | Type | State | Issuer | Description | 1962879940 | 05 | UT | MEDICAID |